OPTIMAL
op·ti·mal
The most desirable; most effective; best place to be. Optimal.
Never has a word like optimal had more meaning than for hypothyroid patients, no matter the cause of their hypothyroidism.
In other words, with worldwide patient experiences and wisdom as shown on this website and books, we have learned the hard way that it’s NOT about just “feeling good” or “being on” any amount of thyroid medication or simply going by symptoms. We have to be optimal with our FT3 lab result with our FT4 lab result, and a low reverse T3 lab result.
Why? Those feel-good symptoms, which can at first be achieved on a non-optimal dose, will eventually backfire for the majority with an unhappy return of hypothyroid symptoms…sooner or later. It varies when patients will see the backfire.
So what is optimal when on thyroid meds/supplements like natural thyroid, T4/T3, or T3-only.
Gaining on nearly two decades of our observations and experiences as revealed by STTM, optimal puts the Free T3 at the top part of the range, and a Free T4 midrange. Both. And to get there without reactions, we have to have good iron and cortisol. Read about iron and cortisol here and what happens if you don’t have good levels when raising these better medications (natural thyroid supplements, T4/T3, or T3-only).
Why does it backfire if we aren’t optimal with our FT3 and FT4?
For one, it’s evident that when we are on these thyroid meds (and if we still have a thyroid), they are going to suppress whatever remaining release of thyroid hormones we still had, even if that release was poor. So to the degree we suppress, we need to replace in an amount that meets our daily, weekly and monthly needs. If we don’t replace enough, it eventually backfires.
And even without a thyroid, we still need the amount that replaces what our body needs to run well to prevent the backfire or a creeping return of hypothyroidism.
But I’ve had problems when I tried to get my FT3 where it needs to be…
That’s about revealing poor levels of either iron and/or cortisol. Read this.
But I feel good when my frees are not optimal…
As stated, most people will notice feeling better on non-optimal doses. But as one stays on those non-optimal doses (that don’t result in an optimal Free T3 with a midrange Free T4), they can see iron levels falls, the adrenals get stressed, lower B12, lower vitamin D, and increased problems that happen quickly, or creep up over time. Why go there!!
Do I test my free’s right after a raise of my NDT or T4 with T3?
Definitely not. If our treatment with T3 meds also include T4 meds (like NDT, or synthetic T4/T3), it takes a few weeks to see the conversion results of T4 to T3. So only after a few weeks after a raise do we test. But if on nothing but T3, we can test the free T3 in about a week.
Can I get optimal on just T4-only like Levo or Synthroid?
It’s very rare to see it on T4-only. And even when someone gets close, it’s not uncommon to still see problems, sooner or later. Sadly, there are too many life situations that can block the conversion of T4 to T3. https://stopthethyroidmadness.com/t4-only-meds-dont-work
I’m seeing my TSH go below range…
Even on non-optimal doses of NDT, T4/T3 or T3-only, it’s typical and expected to see a TSH lab result go below the range. And it will continue being low as we make our way up to an optimal dose.
Sadly, you have to stand firm against doctors who wrongly freak out about that normal low TSH with T3 in your treatment. Our low TSH is not the same as the low TSH seen with Graves’ disease, the hyperthyroid side of the coin that doctors confuse it with. Our low TSH when optimal with the frees does NOT cause bone loss or heart disease–it’s uncontrolled Graves’ disease that can do that, or still being underdosed, or having an iron or cortisol problem keeping us underdosed.
To the contrary, when we are nearing optimal with our free T3 and free T4, or right at it, patients have reported improved bone and heart health!!
<—There is a chapter written by a doctor against the TSH lab test in the STTM II book, seen to your left. You can read a summary about it by clicking on the photo of it here: https://laughinggrapepublishing.com
—>There’s a complete chapter about the TSH in the updated revision STTM book, seen above right. You can read about this book here.
Important note: STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.